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  • Rita, Dayton, Canton, Henderson, Sabine, Houston, and Texarkana
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    1. 1. Hurricanes Katrina and Rita Lessons Learned Texas Nurses Answer the Call Debra Edwards, MS, RNC Texas Education and Distance Learning Coordinator Emergency Preparedness and Response Branch Texas Department of State Health Services
    2. 2. Objectives <ul><li>Differentiate the response role of nurses in Texas related to Hurricanes Katrina and Rita. </li></ul><ul><li>Analyze lessons learn and provide recommendation to enhance the nurses’ response to hurricanes in the future. </li></ul>
    3. 3. Emergency Management + Public Health <ul><li>Focus on point of integration </li></ul><ul><ul><li>National Incident Management System (NIMS) </li></ul></ul><ul><ul><ul><li>NIMS Compliant </li></ul></ul></ul><ul><ul><ul><li>Applicable to all hazards </li></ul></ul></ul><ul><ul><li>Incident Command System (ICS) </li></ul></ul><ul><ul><ul><li>Management Concept </li></ul></ul></ul><ul><ul><ul><li>ICS Structure </li></ul></ul></ul><ul><ul><li>State Emergency Management Plan </li></ul></ul><ul><ul><ul><li>Annex Radiological Emergency Management </li></ul></ul></ul><ul><ul><ul><li>Annex H Health and Medical </li></ul></ul></ul>
    4. 4. Integration <ul><li>NIMS </li></ul><ul><ul><li>Command and Management </li></ul></ul><ul><ul><li>Preparedness </li></ul></ul><ul><ul><li>Resource Management </li></ul></ul><ul><ul><li>Communication and Information Management </li></ul></ul><ul><ul><li>Supporting Technologies </li></ul></ul><ul><ul><li>Ongoing Management and Maintenance </li></ul></ul>Incident Commander Logistics Finance/Adm Planning Operations <ul><li>ICS </li></ul>Safety Officer Liaison Officer PI Officer
    5. 5. Thank You Texas Nurses <ul><li>At the first sign of need nurses did not hesitate…. </li></ul>
    6. 6. A Look Back Rita 9/24/05 Texas near Sabine Pass Cat 3 17 counties were declared disaster areas Katrina 8/29/05 Louisiana near New Orleans Cat 4 Multi states declared disaster areas
    7. 7. A Comparison Katrina Shelters were concentrated in larger cities and affiliated with city and county jurisdictions Nurses Role Collective group of nurses providing services Infrastructure Emergency Management System Rita Shelters were concentrated in smaller cities with a larger number of unaffiliated shelters Nurses Role One or two nurses providing services Infrastructure Disconnected from the Emergency Management System
    8. 8. Partners <ul><li>Texas Nurses Association </li></ul><ul><ul><li>Ready Texas Nurse </li></ul></ul><ul><ul><ul><li>Establish after 9/11 </li></ul></ul></ul><ul><ul><ul><li>Statewide </li></ul></ul></ul><ul><ul><ul><li>Nationwide </li></ul></ul></ul><ul><li>Texas Medical Association </li></ul><ul><ul><li>Medical Society </li></ul></ul><ul><ul><ul><li>Locally </li></ul></ul></ul>
    9. 9. Ready Texas Nurses Nacogdoches, Lufkin, San Augustine, Newton, Tyler, Manor, Livingston, Shelby, Waco, Bryan, Austin, Woodville, etc. Dallas, Houston, Forth Worth, New Orleans, Austin, Garland, San Antonio, Texarkana Areas of Deployment 360 53 Number of Request Rita Katrina
    10. 10. Ready Texas Nurses 6 5 Nurse Practitioner 29 5 LVN 133 125 RN Shelters both official and unofficial, hospitals and clinics Shelters both official and unofficial, hospitals and clinics Location of Deployment Rita Katrina
    11. 11. Ready Texas Nurses * Other systems or databases were utilized to fill request 7* 5* Physician Assistant 27* 53* Physician 60* 0* Nurse Assistant Rita Katrina
    12. 12. Resource Management * Other systems or databases were utilized to fill request 3* 0* EMT/Paramedic 4* 10/30* Pharmacist/Tech 7* 0* Social Workers 5* 5* Mental Health Rita Katrina
    13. 13. Ready Texas Nurses Medical Surgical, Trauma, Emergency Room, OB and Gyn, Intensive Care, Neonatal, and Psychiatry Medical Surgical, Emergency Room, OB and Gyn, Intensive Care, Pediatric, Neonatal, and Psychiatry Specialty Requested Rita Katrina
    14. 14. Resource Management During Event Texas Nurses Association (TNA) Texas Medical Association (TMA) Texas Pharmacy Association (TPA) Texas Department of State Health Services (DSHS) Texas Nurses Association (TNA) Texas Medical Association (TMA) Texas Pharmacy Association (TPA) Texas Department of State Health Services (DSHS) Volunteer Database Rita Katrina
    15. 15. Scope <ul><li>Health and Medical Resources </li></ul><ul><ul><li>The number of nurses who support the health and medical functions to address natural and man-made events can not be measured….. </li></ul></ul>Public Health, Mental and Behavioral Health, Emergency Management, Acute and Long Term Care Facilities All disasters are local… DSHS, DADS, DARS, DFPS, HHSC, etc
    16. 16. Your Experience Counts <ul><li>Group Activity </li></ul><ul><ul><li>What successes did you observe during: </li></ul></ul><ul><ul><ul><li>Katrina </li></ul></ul></ul><ul><ul><ul><li>Rita </li></ul></ul></ul><ul><ul><li>What challenges did you observe during: </li></ul></ul><ul><ul><ul><li>Katrina </li></ul></ul></ul><ul><ul><ul><li>Rita </li></ul></ul></ul><ul><ul><li>What are your recommends to close the gaps or challenges you identified: </li></ul></ul><ul><ul><ul><li>Katrina </li></ul></ul></ul><ul><ul><ul><li>Rita </li></ul></ul></ul>
    17. 17. Successes <ul><li>The Nurses </li></ul><ul><ul><li>Willingness to volunteers </li></ul></ul><ul><li>Texas Ready Nurse System </li></ul><ul><ul><li>Established and functional </li></ul></ul>
    18. 18. Successes <ul><li>Two hurricanes in 30 days… </li></ul><ul><ul><li>Texas Nurses Responded </li></ul></ul><ul><ul><ul><li>Over 3,000 RNs and LVNs answered the Texas Ready Nurse call </li></ul></ul></ul><ul><ul><ul><ul><li>1700 were registered prior to the event. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>1350 registered with TNA or DSHS during the 30 day. </li></ul></ul></ul></ul><ul><ul><ul><ul><li>TNA documented 500 nurses were deployed…79 sent to special needs shelters in East Texas following Rita landfall </li></ul></ul></ul></ul><ul><ul><li>Local Response </li></ul></ul><ul><ul><ul><li>Countless other worked long hours volunteering or fulfilling employer obligations. </li></ul></ul></ul>Texas Nursing September-October 2005
    19. 19. Closing the Gap We need to build upon what is working well …………….. ………… ..Identify challenges, roadblocks and gaps Implement and integrate strategies to close gaps…………. ………………… .revise and test plans
    20. 20. Challenges <ul><li>Governance and Infrastructure Management </li></ul><ul><ul><li>Unclear roles and responsibilities </li></ul></ul><ul><ul><ul><li>Local </li></ul></ul></ul><ul><ul><ul><li>State </li></ul></ul></ul><ul><ul><ul><li>Federal </li></ul></ul></ul>72% of the shelters did not know how to link to their EOC
    21. 21. Challenges <ul><li>Volunteer Management </li></ul><ul><ul><li>Identification and deployment of resources </li></ul></ul><ul><ul><ul><li>Database management </li></ul></ul></ul><ul><ul><ul><ul><li>Affiliated vs. unaffiliated </li></ul></ul></ul></ul><ul><ul><ul><li>What is the system and how will the system be activated? </li></ul></ul></ul><ul><ul><ul><li>Tracking the deployment of resources </li></ul></ul></ul><ul><ul><ul><ul><li>Federal reimbursement </li></ul></ul></ul></ul>
    22. 22. Challenges <ul><li>Risk Management </li></ul><ul><ul><li>Safety of the individual </li></ul></ul><ul><ul><ul><li>Liability </li></ul></ul></ul><ul><ul><ul><li>Training </li></ul></ul></ul><ul><ul><ul><li>Transportation into the “hot zone” </li></ul></ul></ul>
    23. 23. Challenges <ul><li>Quality Assurance </li></ul><ul><ul><li>Uncoordinated services and processes </li></ul></ul><ul><ul><ul><li>How do we get the resources to where they are needed </li></ul></ul></ul><ul><ul><ul><ul><li>Volunteer is needed </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Not turned away </li></ul></ul></ul></ul><ul><ul><ul><li>Mechanism for requesting nursing resources </li></ul></ul></ul><ul><ul><ul><ul><li>Who can request resources </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Emergency management system vs. another process </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Utilization of technology </li></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Web EOC </li></ul></ul></ul></ul></ul>
    24. 24. Challenges <ul><li>Funding and Financial Support </li></ul><ul><ul><li>Sufficient human and financial resources to maintain the system </li></ul></ul><ul><ul><ul><li>Long term, short term </li></ul></ul></ul><ul><ul><ul><li>Sustainability of system </li></ul></ul></ul><ul><ul><ul><ul><li>Start-up, maintenance, and surge capacity </li></ul></ul></ul></ul>
    25. 25. Challenges <ul><li>Communication System </li></ul><ul><ul><li>Lack of a formal communication strategy </li></ul></ul><ul><ul><ul><li>SOC, DDC, EOC, shelters, etc. </li></ul></ul></ul><ul><ul><li>Multiple points of contact </li></ul></ul><ul><ul><ul><li>Emergency management , public health, community based, faith based, etc. </li></ul></ul></ul><ul><ul><li>Disjointed points of communication </li></ul></ul><ul><ul><ul><li>Multi points of contact for he same information </li></ul></ul></ul>
    26. 26. Toward the Future To Address Incidents of national significance in the future we must… Reinforce and utilize the emergency management model to…..
    27. 27. Recommendations <ul><li>Identify and close gaps as soon as possible </li></ul><ul><li>Integrate and incorporate changes into agency and community plans </li></ul><ul><ul><li>Requires a strong communication plan </li></ul></ul><ul><li>Redefine and establish processes that include partners……not exclude </li></ul><ul><ul><li>Associations, CBO, Private and Public Partners </li></ul></ul><ul><li>Connectivity to all resource databases </li></ul><ul><ul><li>Central command center </li></ul></ul><ul><ul><li>Background checks </li></ul></ul>
    28. 28. Recommendations <ul><li>Volunteer Recruitment and Retention </li></ul><ul><ul><li>Resources management </li></ul></ul><ul><li>Exercise plans from a local, regional and statewide perspective including all response partners </li></ul><ul><ul><li>Although all response is local, plans must be integrated to respond quickly when local resources are depleted </li></ul></ul>
    29. 29. Recommendations <ul><li>Ensure volunteers are trained </li></ul><ul><ul><li>Identify skill sets, standardized courses, training, actual and realistic need of volunteers and type resources </li></ul></ul><ul><li>Financial support is critical to sustain a system to deploy nursing volunteer during a event </li></ul>
    30. 30. Gaps Missed Don’t forget……………..
    31. 31. After Action Reviews (AAR)
    32. 32. DSHS- Public Health Response <ul><li>Litaker Group </li></ul><ul><ul><li>Preparing the AAR for DSHS Report due by </li></ul></ul><ul><ul><ul><li>April 1, 2006 </li></ul></ul></ul>
    33. 33. Evacuation of Hospitals and Nursing Homes <ul><li>Hospital and nursing home administrators are often responsible for deciding whether to evacuate patients from their facilities </li></ul><ul><li>State and local governments can order evacuations of populations, but health care facilities may be exempt from these orders </li></ul><ul><li>Hospitals and nursing homes administrators stated they evacuate only as a last resort and that emergency plans are designed primarily to shelter-in-place </li></ul><ul><li>Administrators consider several issues when deciding to evacuate or shelter in place: </li></ul><ul><ul><ul><li>Availability of adequate resources </li></ul></ul></ul><ul><ul><ul><li>Risk to patients </li></ul></ul></ul><ul><ul><ul><li>Availability of transportation to move patients and of receiving facilities to accept patients </li></ul></ul></ul><ul><ul><ul><li>Destruction of the facilities or community’s infrastructure </li></ul></ul></ul>United States Government Accountability Office, 2/16/06
    34. 34. Hurricane Evacuation Issues <ul><li>Recommendations </li></ul><ul><ul><li>Command control and communications </li></ul></ul><ul><ul><li>Evacuation of people with special needs </li></ul></ul><ul><ul><li>Fuel availability </li></ul></ul><ul><ul><li>Traffic flow </li></ul></ul><ul><ul><li>Public Awareness </li></ul></ul>Governor’s Task Force on Hurricane Evacuation Issues 2/20/06
    35. 35. Thank You Questions